Localized and diffuse ovarian cancer: is it the same entity?

Scintigraphic methods used in intraoral and extraoral implantology allow the evaluation of bone metabolism in the peri-implant zones, providing anatomic images and functional dynamics information on the osteointegration process. Twenty-five patients who underwent implantation operations for the application of intra- and extraoral prostheses were studied using technetium 99 m single photon emission computed tomographic (SPECT) procedures to evaluate osteointegration dynamics at 3 weeks, and 3, 6, 12, and 24 months. The study demonstrates that radiation emission peaks 3 weeks after surgery with the maximal bone remodeling activity and 6 months after surgery after the functional loading of the implants only in intraoral fixtures. High uptake past the eighth month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three-dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional-type radiological procedures introduces new possibilities, although still in the clinical experimentation phase, for early diagnosis and inserted implant prognosis.     

Evaluating the effect of superficial temporal artery to middle cerebral artery bypass on pure motor function using motor activation single photon emission computed tomography

OBJECTIVE: We evaluated and analyzed the effect of superficial temporal artery to middle cerebral artery bypass for internal carotid artery occlusion on pure motor function using motor activation single photon emission computed tomography. METHODS: Motor activation single photon emission computed tomographic (SPECT) images were obtained for nine patients who had undergone superficial temporal artery to middle cerebral artery anastomosis for symptomatic internal carotid artery occlusion. All motor activation SPECT images using the finger opposition task on the affected side were obtained before bypass surgery and at 1 week, 1 month, and 3 months after bypass surgery. The results of motor activation single photon emission computed tomography were expressed as negative or positive. RESULTS: Before bypass surgery, the resting SPECT images revealed reduction of cerebral blood flow (CBF) on the affected side in all nine patients. The results of motor activation single photon emission computed tomography in three patients were positive. One week after bypass surgery, the results of the resting and motor activation CBF studies did not demonstrate any marked changes. One month after bypass surgery, the resting CBF increased in four patients. The results obtained for two of the patients revealed preoperative positive motor activation. The results of motor activation single photon emission computed tomography obtained for five patients were positive. Three months after bypass surgery, eight patients experienced improvement in the resting CBF, and the results of motor activation single photon emission computed tomography obtained for seven patients were positive. Among these, the results of preoperative motor activation single photon emission tomography obtained for four patients were negative. CONCLUSION: Superficial temporal artery to middle cerebral artery bypass is useful not only for resting CBF but also for pure motor function based on motor activation SPECT images. From the preoperative motor activation study, it was concluded that patients with preoperative positive motor activation could attain the effect of bypass earlier than patients with preoperative negative motor activation.     

Synthesis and biological evaluation of the analogs of bioxanthracenes ES-242s, N-methyl-D-aspartate antagonists

AIM AND BACKGROUND: A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. METHODS: The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. RESULTS: After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. CONCLUSIONS: There is no balance between price list and effective cost of the different surgical reconstructive procedures, which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regions and hospitals to improve the service, keeping it at a good level.     

Hydroxyapatite implantation with scleral quadrisection after evisceration

BACKGROUND AND OBJECTIVES: In contrast to the literature on enucleation, reports of hydroxyapatite (HA) implantation during evisceration are limited; however, those that have been published mention the high HA exposure rate. The authors examined the scleral quadrisection procedure to evaluate its effect on cosmetic appearance and the prevention of HA exposure after evisceration. PATIENTS AND METHODS: The authors analyzed the surgical outcomes of 17 patients who had undergone an HA implantation with scleral quadrisection after evisceration between November 1994 and November 1995. RESULTS: In each case, the authors were able to use HA implants of 18 mm or more. During follow-up (average 10.7 months), there were no cases of conjunctival erosion, HA exposure, implant migration, significant enophthalmos, or superior sulcus deformity. All of the patients, 7 of whom had a ball- and-socket prosthesis, were satisfied with their cosmetic appearance and prosthetic motility. More than 11 weeks after evisceration, all 10 studied patients had complete, round uptakes with orbital bone SPECT (single photon emission computed tomography). CONCLUSION: For good cosmetic appearance and for the prevention of implant exposure, scleral quadrisection is a safe and effective procedure for HA implantation after evisceration.     

Cardiac surgery in hemodialysis patients

Five hemodialysis patients have undergone cardiac procedures between March 1986 and August 1992. These cases include two coronary artery bypass operations and three valve replacements. The average time on dialysis prior to surgery was 67 months and all patients were in NYHA grade 3 or 4. All patients were dialyzed two or three consecutive days before surgery. Intraoperative extracorporeal ultrafiltration method (ECUM) was used in all patients. In one patients hemodialysis was also performed intraoperatively in addition to ECUM. All patients received platelet transfusions after cardiopulmonary bypass because of known platelet dysfunction and coagulation problems in renal failure patients. Our first patient, who had been dialyzed on operative day using regional heparinization, returned operating room for bleeding on the first postoperative day, then in another four patients hemodialysis was begun on the first or second postoperative day using nafamostat mesilate as anticoagulant. No perioperative deaths occurred and all patients remain alive with a mean follow-up of 28 months. In summary, cardiac surgery can be successfully carried out on five chronic hemodialysis patients, hemodialysis can be performed safely on early postoperative day, and nafamostat mesilate is a useful anticoagulation agent to prevent postoperative bleeding complications.     

Use of demineralized bone implants in orbital and craniofacial reconstruction and a review of the literature

A retrospective study and review of the literature was performed on the use of demineralized bone implants for the correction of orbital and craniofacial defects. Demineralized bone implants heal by endochondral osteogenesis, inducing a transformation of local cells, as well as by osteoconduction, similar to autogenous grafts. They induce the chemotaxis and transformation of mesenchymal cells into chondroblasts, followed by ossification. They also act as a scaffold, with bone resorption taking place simultaneous with bone formation. This study reviewed 21 patients and 31 orbits, in which demineralized bone was used for orbitocranial reconstruction for congenital deformities (nine patients), after surgery for orbital fractures (seven patients: four floor, three roof), and orbital tumors (five patients). The surgical technique is described, and the results are discussed. The follow-up period averaged 15 months (6 months to 33 months). The overall resorption rate of the demineralized bone implants was estimated based on follow-up radiologic studies (facial films, computed tomography scans, and magnetic resonance imaging scans), as well as clinical examinations. All patients had a satisfactory to excellent result. The demineralized bone and Grafton (Osteotech, Shrewsbury, NJ, U.S.A.) was obtained from the Musculoskeletal Transplant Foundation of Holmdel, New Jersey, and it was all processed and reconstituted in a standard manner with Alloprep System. Surgical complications were cerebrospinal fluid leaks (one patient) with infection, transient chemosis, enophthalmos, and hypophthalmos. There were no complications related to demineralized bone alone. Properly prepared demineralized bone is a safe material for orbital reconstruction that eliminates the need for a second operative site to harvest a bone graft.     

Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.     

Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography

OBJECTIVES: This study assessed the incremental prognostic implications of normal and equivocal exercise technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) and sought to determine its incremental prognostic value, impact on patient management and cost implications. BACKGROUND: The prognostic implications of Tc-99m sestamibi SPECT are not well defined, and risk stratification using this test has not been explored. METHODS: We studied 1,702 patients referred for exercise Tc-99m sestamibi SPECT who were followed up for a mean (+/- SD) of 20 +/- 5 months. Patients with previous percutaneous transluminal coronary angioplasty or coronary artery bypass surgery were excluded. The SPECT studies were assessed using semiquantitative visual analysis. Cardiac death and myocardial infarction were considered "hard" events, and coronary angioplasty and bypass surgery > 60 days after testing were considered "soft" events. RESULTS: Of the 1,702 patients studied, 1,131 had normal or equivocal scan results. A total of 10 events occurred in this group (1 cardiac death and 1 myocardial infarction [0.2% hard events]; 4 coronary angioplasty and 4 bypass surgery procedures [0.7% soft events]). The rates of hard events and referral to catheterization after SPECT were similarly low in patients with a low (< 0.15), intermediate (0.15 to 0.85) and high (> 0.85) post-exercise treadmill test (ETT) likelihood of coronary artery disease. With respect to scan type, patients with normal, probably normal or equivocal scan results had similarly low hard event rates. In the 571 patients with abnormal scan results, there were 43 hard events (7.5%) and 42 soft events (7.4%) (p < 0.001 vs. 1,131 patients with normal scan results for both). When the complete spectrum of scan responses was considered, SPECT provided incremental prognostic value in all patient subgroups analyzed. However, the nuclear scan was cost-effective only in patients with interpretable exercise ECG responses and an intermediate to high post-ETT likelihood of coronary artery disease and in those with uninterpretable exercise ECG responses and an intermediate to high pre-ETT likelihood of coronary artery disease. CONCLUSIONS: Normal or equivocal exercise Tc-99m sestamibi study results are associated with a benign prognosis, even in patients with a high likelihood of coronary artery disease. Although incremental prognostic value is added by nuclear testing in all patient subgroups, a testing strategy incorporating nuclear testing proved to be cost-effective only in the groups with an intermediate to high likelihood of coronary artery disease before scanning.     

Influence of breastfeeding and complementary food on growth between 5 and 10 months

OBJECTIVE: To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD). DESIGN: Prospective study in comatose and brain-dead patients. SETTING: Neurologic ICU. PATIENTS AND METHODS: Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD. INTERVENTIONS: Brain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360 degrees, 88 images). MEASUREMENTS AND RESULTS: All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of "empty skull"); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later. CONCLUSIONS: Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.     

Epitope analysis of the human p53 tumour suppressor protein

Allogenic, preserved cartilage is often used for reconstruction of face. This study was undertaken to analyze the effects of cartilage transplantation. In analyzed group of 437 patients after cartilage transplantation, 42.2% were operated because of posttraumatical changes, 29.0% because of congenital malformations. In 16.7% nonspecific inflammations were the cause of reconstructive operations. Malformations were mainly localised in nose 59%, ear concha 16.5% and mandible 10.9%. Human costal cartilage, preserved in 0.9% NaCl and radiation-sterilized was used for reconstruction. 24-190 months after surgery (in several clinical units) patients were examined and results were collected in special questionnaire by the team who performed surgery. The results of treatment were compared with age, diagnosis and localisation of changes. It was found that very good result of treatment was achieved in 33.5% of patients, in 41.8% result was satisfactory. In 19.9% of operated patients result of treatment was unsatisfactory. Correlation of some clinical and biological characteristics with the result of treatment is discussed.     

Bone SPECT of the jaws after fracture, onlay osteoplasty of insertion of implants

AIM: The aim of this study was early differentiation between uncomplicated and complicated processes of healing in the jaw using bone SPECT. METHODS: Investigations were performed in 40 mandibular fractures and 26 jaws after onlay osteoplasty as well as secondary insertion of implants. Bone SPECT was carried out within 1-2 months and after approximately 4-5 months. The uptake in the jaw was assessed semi-quantitatively using ROI analysis. RESULTS: Fractures with uncomplicated healing showed a decrease of uptake in follow-up, whereas fractures with an infection in the later course showed an increase, resulting in a significantly higher uptake at the follow-up investigation for the latter group. 1-2 months after onlay osteoplasty significantly lower uptake was found in regions with later occurrence of sequestration. In regions with implants in which osseointegration failed, there was significant reduction of uptake initially and significant elevation at the follow-up investigation. CONCLUSION: These results indicate a prognostic relevance of bone SPECT in the evaluation of processes of healing in the jaw.     

The expression of regenerative growth factors in chronic liver injury and repair

The outcomes of surgical reconstruction for patients who have undergone extensive tumor resection of the mandible and associated soft tissue have been less than desirable for many reasons: lack of cancer cure, radiation problems, as well as inadequate functional reconstructive results. These patients traditionally have undergone multiple surgical procedures for restoration of the surgical deformity. With the advent of new donor sites and successful transfer of microvascular hard and soft tissue, one can restore the largest defects created during cancer excision. Combining these techniques with biocompatible dental implants and reconstructive bone plates, technology has advanced to the point of predictable outcomes. The restoration of appearance, mandibular function, and mastication is mandated by patients. Dental implants are now placed in vascularized bone reconstruction of the mandible immediately at the time of ablative surgery. This obviates the need for additional surgical reconstructive procedures, adjunctive hyperbaric oxygen therapy, and problems associated with the placement of dental implants in irradiated tissue.     

99m technetium-ethyl-cysteinate-dimer single-photon emission CT can predict fatal ischemic brain edema

BACKGROUND and PURPOSE: We sought to study the prognostic value of early 99mtechnetium-ethyl-cysteinate-dimer single-photon emission CT (99mTc-ECD SPECT) for fatal ischemic brain edema in patients with middle cerebral artery (MCA) stroke compared with the prognostic value of CT and of clinical findings. METHODS: We prospectively studied 108 patients clinically, with 99mTc-ECD SPECT, and with CT within 6 hours of symptom onset (Scandinavian Stroke Scale <40 points) appropriate to MCA ischemia. The follow-up consisted of Scandinavian Stroke Scale and CT on days 1 and 7, Barthel Index, and Modified Rankin Scale after 3 months. An activity deficit of the complete MCA territory on the SPECT scans and a parenchymal hypoattenuation of the complete MCA territory on CT scans were considered as predictors for a fatal MCA infarction due to mass effect and midbrain herniation. RESULTS: In 11 of 108 patients (10%), the MCA infarction was the cause of death. The sensitivity of SPECT for fatal outcome was 82% in both visual and semiquantitative analyses, while specificity was 98% and 99%, respectively. The sensitivity and specificity of baseline CT were 36% and 100%, respectively; the sensitivity and specificity of clinical findings (Scandinavian Stroke Scale, depressed level of consciousness, gaze deviation) varied from 36% to 73% and from 45% to 88%, respectively. In a multivariate logistic regression model, only SPECT findings were found to be independent predictors of malignant MCA infarction/death. CONCLUSIONS: We were able to identify patients with fatal MCA infarction with high accuracy by using 99mTc-ECD SPECT within 6 hours of stroke onset. This technique offers great potential to select stroke patients for specific therapies, eg, decompressive hemicraniectomy, soon after onset of symptoms.     

Vitamin D-retinoid association: molecular basis and clinical applications

BACKGROUND AND PURPOSE: The role of single-photon emission CT (SPECT) in the prognosis of cerebral infarction is controversial, but most studies report that SPECT using a variety of radiopharmaceutical agents gives useful prognostic information. Only one study has questioned whether acute perfusion deficits independently add to a valid clinical prognostic score. This study was limited to middle cerebral artery territory infarcts and was negative. We present data on the prognostic utility of SPECT using 99mTc-hexamethylpropyleneamine oxime (HMPAO) in cerebral infarction, unselected by site. METHODS: Fifty consecutive unselected patients admitted to the hospital with acute cerebral infarction, of whom 10 died and 7 withdrew, had SPECT performed serially at onset and at 1 week and 3 months after stroke onset using 99mTc-HMPAO and the NOVO 810 dedicated high-resolution head tomograph. Clinical severity at presentation and outcome was measured with the Canadian Neurological Scale and the Barthel Index. Infarct volumes were measured from both the SPECT and CT scans. The data for the 43 subjects who completed the study or died were evaluated to determine the most powerful prognostic measures. Predictors were the Canadian Neurological Scale score at onset and 1 week, the Barthel Index at 1 week, the CT infarct volume typically done between 3 and 7 days after stroke onset, and the infarct volumes at the first and second SPECT. Outcome measures were the Canadian Neurological Scale score and Barthel Index score at 3 months, scored as zero for those patients who died. RESULTS: The clinical prognostic indicators correlated with the outcome measures, with coefficients between .617 and .821 (P < .0006 in all cases). The Canadian Neurological Scale score measured at 1 week was the best of these. Infarct volumes measured from SPECT correlated less well (coefficients between -.518 and -.683, P < .0019 in all cases). CT infarct volume was the poorest predictor. Although SPECT infarct volumes predicted outcome, they did so less well than clinical examination. Spontaneous infarct reperfusion did not affect outcome. CONCLUSIONS: Although the measurement of infarct volume on SPECT using 99mTc-HMPAO provides a predictor of stroke outcome, it is not a better predictor than the Canadian Neurological Scale score.     

Silicone breast implants: immunotoxic and epidemiologic issues

Silicone gel implants for breast augmentation and reconstruction have been in use since 1962. Significant local complications include capsular contracture, rupture, gel "bleed", and spread of the implant material to regional lymph nodes (1-7) as well as histologic findings of foreign body granulomas in the capsular tissue and in lymph nodes (7-9). Through magnetic resonance spectroscopy and atomic emission spectroscopy, silicon compounds were found in the blood of some women with silicone breast implants; silicone and silica have also been found in liver (10). Well-publicized case reports have raised significant concerns regarding an association between implants and systemic disease. However, despite the availability of silicone implants for over 30 years, controlled epidemiological studies were not carried out until 1992. Currently available epidemiologic data are extremely limited. In part, because the majority of implants were used after 1981, the incidence of long-term problems is not yet known. In 1992, due to the unavailability of studies demonstrating the safety of implants, the U.S. Food and Drug Administration advised that silicone breast implants should be used only in reconstructive surgery and as part of clinical trials (11). This decision spurred a wave of research on the bioreactivity of silicone and clinical observations of patients with implants. Herein, we review the adverse immune effects following contact with silicone as well as the epidemiologic data available.     

Serial gadolinium-enhanced MR imaging after lumbar disc resection: observation of the affected root

A prospective study was undertaken to clarify the relationship between postoperative morphological/pathological changes in the affected root and the clinical developments after disc resection. Gadolinium-enhanced magnetic resonance (MR) imaging was performed at 1 week, 5 weeks, 3 months, and 6 months after surgery for 28 patients of 34 consecutive patients who underwent single-level disc resection. Enhancement/thickening of the affected root was found to be 100%/89% at 1 week, 50%/57% at 3 months, and 32%/37% at 6 months after surgery. Patients with root enhancement and thickening at 3 and 6 months after surgery had less clinical improvement than patients without it. There was consistent correlation between postoperative clinical developments and nerve root enhancement/thickening in enhanced MR imaging. To use enhanced MR imaging as an evaluation tool after disc surgery might increase the diagnostic accuracy and reduce failed back surgery syndrome.     

Partial colpocleisis for vesicovaginal fistulas

Four patients with a vesicovaginal fistula were operated upon transvaginally using the Latzko technique of partial colpocleisis. In 3 of the 4 patients, the fistulas had been formed after total hysterectomy for myoma uteri or endometriosis. The periods from fistulization-to-surgery intervals in these 3 patients were 4 months, 12 months, and 4 years and 4 months, respectively. The fistulas in the remaining one patient had been formed after forceps delivery. The patient underwent surgery 8 days after delivery. An indwelling catheter was retained for 3 to 14 days after surgery. The 4 patients were all cured of vesicovaginal fistulas after a single operation. This paper describes our partial colpocleisis technique and discusses its clinical utility. The partial colpocleisis has the advantages of dispensing with such procedures as fistula excision, fistula opening suture, and suturation of the bladder musculature, and of closing the fistulas using a demucosated vaginal wall. Having minimal surgical invasiveness and being easy to perform and reliable, the technique appears to be excellent for coping with vesicovaginal fistulas.     

Kinetical analysis of tumor cell death-inducing mechanism by polymorphonuclear leukocyte-derived calprotectin: involvement of protein synthesis and generation of reactive oxygen species in target cells

Nasal reconstruction presents a significant challenge to the facial plastic surgeon. Reestablishment of the desired aesthetic nasal contour and restoration of respiratory function are the dual goals of this endeavor. While autologous cartilage or bone is considered optimal grafting material, the supply is often limited and harvesting entails additional morbidity. Many synthetic materials have been introduced for use in nasal reconstruction, but high infection and extrusion rates have left most surgeons dissatisfied with conventional implants. Porous polyethylene (Medpor) implants were used for nasal reconstruction in 187 patients; 66 (35.3%) patients underwent primary rhinoplasty, while revision surgery was performed in 121 (64.7%) patients. Most patients required multiple implants, including columella struts, plumper grafts, dorsal tip implants, and nasal valve battens. Postoperative follow-up ranged from 6 months to 3.5 years. Complications occurred in five (2.6%) patients. Three early and two delayed infections necessitated implant removal in five patients, all of whom had compromised skin-soft tissue envelopes secondary to heavy smoking, cocaine abuse, or prior surgery. One case of an overly augmented nasal dorsum and tip required implant removal, reduction, and reinsertion. All implants were easily removed. No other complications including implant extrusion or skin erosion have been noted. Porous polyethylene (Medpor) implants allow for fibrovascular ingrowth, which lends stability to the implant. Porous polyethylene implants are well tolerated and provide an ideal material for nasal reconstruction.     

Management of late induced abortions in France

OBJECTIVE: To evaluate the clinical results of comminuted patella fracture fixation after an extensile surgical approach by using a tibial tuberosity osteotomy. DESIGN: Prospective, clinical. PATIENTS: Six knees with displaced comminuted patella fractures had stable internal fixation after an osteotomy of the tibial tubercle. All had immediate postoperative continuous knee motion and were followed for an average of thirty-one months (minimum of eighteen months). OUTCOME MEASURES: Time to clinical and radiographic union, Hospital for Special Surgery (HSS) Knee Scores and comparisons with literature cohort studies. RESULTS: Clinical union of the osteotomy occurred at an average of eight weeks (range 6 to 12 weeks) and of the patella fractures at an average of eleven weeks (range 8 to 21 weeks). There was no radiographic evidence of osteotomy displacement, fracture implant loosening, migration, or failure. All patients had clinical residua, which included loss of motion, thigh muscle atrophy, and barometric complaints. HSS Knee Scores averaged 75 points with four good, one fair, and one poor result. These results were comparable to those of previously published reports of ablative surgery for this type of fracture. CONCLUSION: Comminuted patella fractures are severe injuries that usually result in some lingering morbidity. Internal fixation preserves bone stock, which facilitates future reconstructive procedures. The described tibial tuberosity osteotomy, patella eversion technique of fracture exposure improved visualization and reduction of the articular surface. The osteotomy healed in all cases and did not adversely affect the clinical results.     

Using ARROWSMITH: a computer-assisted approach to formulating and assessing scientific hypotheses

The usefulness of Xe-133 and Tc-99m-MAA single photon emission computed tomography (SPECT) in identifying areas to be resected during video-assisted thoracoscopic lung reduction surgery for emphysema was examined. Twenty-nine patients with advanced emphysema were examined using Xe-133 and Tc-99m-MAA SPECT prior to and following surgery. For the Xe-133 dynamic SPECT, patients inhaled Xe-133 gas for 6 minutes. Equilibrium and subsequent washout SPECT images were acquired every 30 seconds for 6 to 7 minutes during spontaneous breathing. Ventilation was quantified by Xe-133 clearance time (T1/2) in addition to visual assessment. The patients underwent unilateral thoracoscopic volume reduction in the regions with abnormal Xe-133 retention and Tc-99m-MAA defect. All patients demonstrated marked, heterogeneous Xe-133 retention and Tc-99m-MAA defects preoperatively. The worst functioning areas were identified as nonventilated and noflow areas, or areas with air trapping and low perfusion. These changes were found even in patients with diffuse and symmetrical impairments on chest CT. After surgery, most of these "target areas" disappeared and pulmonary function tests demonstrated significant improvement. T1/2 correlated closely with the percent predicted FEV1 (%FEV) and 6-minute walk distance before and after surgery (p<0.0001). Xe-133 and Tc-99m-MAA SPECT imaging was useful in identifying "target areas" in the emphysematous lung. Directed unilateral thoracoscopic volume reduction based on these SPECT images is an effective treatment for emphysema.